The growth of managed care is forcing clinical laboratories to produce rapid, efficient testing services and to focus on cost reduction. The clinical testing services market is highly competitive, with large independent reference laboratories increasing the standard in terms of technology, speed of testing, and price.
Many laboratorians interviewed suggested that the future of the commercial reference laboratory industry centered on the development of sophisticated informatics products that will be able to integrate laboratory results data with outcomes data from other health system players. Some large clinical laboratory companies have reported making large in
An important element of the public and private laboratory function is to communicate with other laboratories, health care practitioners, and public health officials. Electronic reporting of laboratory test results to the ordering physician has become routine in most large hospitals. But this function is also critical in PHLs, since much of the tes
Most environmental testing is automated. However, with the exception of newborn screening most microbiology testing is not automated. In part, this is because the more comprehensive testing offered by the state PHL does not readily lend itself to automation. In addition, the PHL's ability to obtain new equipment has been hampered by budget constra
Virtually all interviewees believe that automation can increase the efficiency of a laboratory. Automation of the commercial reference laboratory market is a well established industry whose vendors include Cerner Corporation, Citation, MediQuest, SMS, and SunQuest Information Systems, Inc. Commercial LIS systems were originally designed to assist
Public Health Laboratories and Health System Change . Universal Coding Systems for Clinical Laboratories
The creation of a standardized set of codes to describe laboratory tests and their results is a necessary prerequisite to efficient information exchange, and there have been a number of efforts to establish such codes. While laboratory services have been included in the establishment of general medical standards (e.g., ASTM, SNOMED, HL-7), the log
Automation of key functions promises to dramatically improve the way that laboratories operate in the future. Internal operations, epidemiologic surveillance, communication with private laboratories, and use of test results could all be enhanced through the implementation of consistent laboratory information systems (LISs). In the private sector,
The growth of managed care has had a significant impact on the operations and profitability of clinical laboratories during the past five years. Cost reduction is the major driving force in the industry, and laboratories are in the process of planning strategically to adapt to these changes. As a result, the key market trends in clinical testing s
Nationwide, the clinical testing market generates $30 billion in sales annually, and currently there are approximately 150,000 clinical laboratories in the United States (including PHLs). Clinical laboratories typically fall into one of three major categories: hospital-based laboratories, independent reference laboratories, and physician office la
As the private sector counterparts to PHLs, and also as an increasing source of competition, private clinical laboratories are a central element of the PHL operating environment.
1 MeSH is the controlled vocabulary of some 18,000 terms used by the National Library of Medicine for its bibliographic databases, including MEDLINE and HealthSTAR. MeSH is a hierarchical controlled vocabulary arranged in a tree structure, in which broader MeSH headings lead to more specific MeSH headings. 2 Institute of Medicine, Committee
Most federal involvement with state PHLs is via the CDC. In addition, several other federal health agencies operate laboratories related to public health. FDA, EPA, USDA
Public Health Laboratories and Health System Change . Centers for Disease Control and Prevention and PHLs
Because of the close tie between the PHL core laboratory functions and the disease surveillance and epidemiology functions of the CDC, the greatest potential for collaboration between PHLs and the federal government lies within the CDC. The PHL relationship with the CDC is robust, and one that is important for national disease surveillance.
Various federal government agencies are currently involved, directly or indirectly, in clinical laboratory issues. From direct oversight of the quality of clinical laboratories to coordination of disease reporting efforts, federal agencies play a vital role in the practices of PHLs. At the present time, the CDC and FDA work most closely with PHLs
The PHL is a central part of the public health infrastructure. PHLs support the public health infrastructure in each of the three core public health functions. Descriptions of PHL activities within these core functions have been previously described by the CDC and the ASTPHLD: 3, 4, 5
Before discussing the specific activities of PHLs, it is first important to characterize the larger public health infrastructure in which PHLs reside. In a 1988 report entitled The Future of Public Health by the Institute of Medicine (IOM), the report attributed many of the major improvements in the health of the American people to the success o
Public Health Laboratories and Health System Change . Policy Context and Background: Environmental Scan
The purpose of this environmental scan is to provide some general context on public health laboratories and the laboratory services marketplace. In this section, we report on the components that constitute the laboratory services marketplace. We describe the PHL's role as part of the public health infrastructure; provide an overview of PHL activit
Because our subject matter has not been widely studied, we initiated a broad literature review consisting of four components: (1) search of peer reviewed literature; (2) search of grey literature; (3) internet search; and (4) review of the CDC's Morbidity and Mortality Weekly Report (MMWR). We also accessed literature by asking our interviewees fo
Due to the novelty of the topic and the consequent paucity of published information, it was necessary to go beyond the available literature by conducting interviews of public and private experts in clinical laboratory issues. We also performed case studies of states with PHLs that have had experience in dealing with health market change in order t
This study examines the role of public health laboratories (PHLs) in the changing health care market, with an emphasis on delineating the relationship between PHLs and managed care. The topic is becoming the focus of considerable attention, particularly as the growth of managed care continues to alter the landscape of health care, and as emerging